Saliva as an alternative to blood in the determination of uremic state in adult patients with chronic kidney disease: a systematic review and meta-analysis.

OBJECTIVES: To assess whether salivary urea and creatinine levels accurately reflect their serum levels in blood samples of adults to detect chronic kidney disease. MATERIALS AND METHODS: A systematic review was conducted in eight electronic databases. The protocol was registered in PROSPERO. Only diagnostic test studies were included. The JBI critical appraisal tools assessed the risk of bias. A meta-analysis of proportions was performed. The GRADE tool assessed the quality of evidence and strength of recommendation across the studies included. RESULTS: Eight studies met the eligibility criteria and were included. Six studies assessed salivary urea, and six studies assessed salivary creatinine. All studies presented moderate risk of bias. The meta-analysis depicted an overall sensitivity of 93.3% (95% CI = 88.6; 97.9) for salivary creatinine levels and 87.5% (95% CI = 83.2; 91.8) for salivary urea levels, while the overall specificity was 87.1% (95% CI = 82.8; 91.3) and 83.2% (95% CI = 65.0; 101.4) for salivary creatinine and urea levels, respectively. The overall accuracy of salivary creatinine was 5.2 percentage points higher compared with salivary urea levels (90.8% vs. 85.6%). According to the GRADE tool, the analysed outcomes were classified as having low to moderate level of certainty. CONCLUSION: Compared with blood samples, salivary urea and creatinine levels presented high diagnostic values for chronic kidney disease screening, but should not be considered equivalent to levels obtained from blood at stages three, four, or five of the disease. CLINICAL SIGNIFICANCE: Chronic kidney disease patients could receive a clinically significant benefit from replacing blood with saliva for potentially monitoring renal function. Saliva collection presents greater simplicity, comfort, safety, and lower collection cost.

Medium Cut-Off Dialysis Membrane and Dietary Fiber Effects on Inflammation and Protein-Bound Uremic Toxins: A Systematic Review and Protocol for an Interventional Study.

The aim of this systematic review is to investigate the effects of the use of a medium cut-off membrane (MCO) and dietary fiber on the concentration of protein-bound uremic toxins (PBUTs) and inflammatory markers in hemodialysis (HD) patients. Of 11,397 papers originally found, eight met the criteria of randomized controlled trial design. No study examined the effects of MCO membranes on PBUTs. Three studies examined the reduction in inflammatory markers with MCO membranes compared to high-flux HD membranes and showed no significant differences. Five studies of dietary fiber supplementation showed an inconclusive positive effect on PBUT levels and a significant positive effect on the reduction in inflammatory markers (interleukin-6 reduction: standardized difference in means -1.18; 95% confidence interval -1.45 to -0.9 for dietary fiber supplementation vs. control; p < 0.001). To date, no study has combined the use of an MCO membrane and fiber supplementation to reduce PBUT levels and inflammation with online hemodiafiltration as a comparator. A rationale and protocol for an interventional trial using a combination of MCO membrane dialysis and fiber supplementation to lower inflammatory markers and PBUT concentrations are presented.

Saliva composition and upper gastrointestinal symptoms in chronic kidney disease.

OBJECTIVE: To investigate self-reported upper gastric symptoms experienced by patients with chronic kidney disease (CKD) and compare associations between uraemic symptoms and saliva composition. METHODS: In a cross-sectional observational study, 30 patients with Stages 4 and 5 CKD were selected from a tertiary hospital renal outpatient clinic. Subjects answered a questionnaire to assess upper gastrointestinal (GI) symptoms. A saliva sample was collected to determine biochemical composition. Possible associations between saliva composition and uraemic upper GI symptoms were assessed. RESULTS: Only 3 (10%) patients reported no upper GI symptoms whilst 19 (63%) complained of a dry mouth, 16 (56%) had a change in taste, 9 (30%) had nausea, 7 (23%) vomited and 7 (23%) dry retched. Lower saliva bicarbonate concentration related to both dry mouth (p < 0.003) and dry retching (p < 0.01). An elevated level of saliva calcium was also implicated in a dry mouth sensation (p < 0.01). Nausea was associated with higher saliva sodium levels (p < 0.03) and a higher saliva sodium/potassium ratio (p < 0.02). CONCLUSION: Altered saliva composition in patients with Stages 4 and 5 CKD may be associated with uraemic upper GI symptoms. In particular, lower saliva concentrations of bicarbonate are associated with dry mouth and retching. Higher saliva calcium levels are also related to a dry mouth whilst higher saliva sodium levels and a greater sodium/potassium ratio are associated with nausea. Further studies investigating strategies to improve uraemic symptoms via changes in saliva are required.

Complications mimicking lupus flare-up in a uremic patient undergoing pegylated liposomal doxorubicin therapy for cervical cancer.

Patients with systemic lupus erythematosus (SLE) have an increased risk for malignancy and end-stage renal disease itself might further augment the risk. Treating uremic patients with cervical cancer by cisplatin-based chemotherapy combined with radiation is hampered by the reduced renal excretion of cisplatin. Doxorubicin, a potential radiosensitizer with an established effect on carcinomas that arise in the ovary, uterine cervix and endometrium, might be applied in these cases. We describe a 36-year-old woman, who had a 9-year history of SLE and was maintained on dialysis, and who developed severe drug reaction manifesting as fever, skin rash and exfoliative dermatitis with positive lupus band test after infusion of pegylated liposomal doxorubicin therapy for advanced cervical cancer. These skin manifestations improved after i.v. methylprednisolone pulse therapy.

[Results of bone scintigraphy, densitometry and radiography in secondary hyperparathyroidism in patients with chronic renal failure]. / Wyniki scyntygrafii, densytometrii i radiografii kosci we wtórnej nadczynnosci przytarczyc u chorych na przewlekla niewydolnosc nerek.

UNLABELLED: Secondary hyperparathyroidism occurs frequently in patients with chronic renal failure (CRF). Cardinal manifestations in patients with secondary hyperparathyroidism involve also skeletal changes. Hence the aims of our studies were detailed investigations of bones using isotope scintigraphy (99mTc-MDP), densitometry (DEXA-Lunar) and radiography, in a group of 34 patients with advanced secondary hyperparathyroidism with very high PTH serum concentrations. Bone mineral density of radius amounted to 74.14 +/- 14%, and 29 cases had osteoporosis, and 5 cases osteopenia. Bone mineral density of vertebral bodies was 85.6 +/- 10.5% was within osteopenia range in 16 cases, osteoporosis in 11 cases and was normal in 6 cases. Bone scintigraphy revealed: excessive tracer uptake in cranial vault, mandible, spine and lateral parts of the sacral bone. Tracer accumulation was decreased in soft tissues and absent in kidneys. Roentgen studies revealed changes typical to secondary hyperparathyroidism: acroosteolysis in 60% of cases, subperiosteal resorption in 43% of cases, calcifications in 20% of cases, cortical fibrosis in 35% of cases and osteoporosis in 85% of cases. CONCLUSIONS: 1. Bone mineral density is markly decreased in the radius and to a lower extent in the vertebral bodies, hence DEXA studies of radius are most appropriate for evaluation of mineral bone density. The differences in BMD are characteristic of hyperparathyroidism, both primary and secondary. 2. In most patients bone scintigraphy shows characteristic abnormalities, thus scintigraphy is helpful in the diagnosis of advanced secondary hyperparathyroidism. 3. In x-ray studies osteoporosis is frequently observed, other signs of secondary hyperparathyroidism are not so common and appear in later stage of disease than decreased bone mineral density in densitometry.